Septic shock patients admitted to the intensive care unit with higher SOFA score tend to have higher incidence of abdominal compartment syndrome - a preliminary analysis.

BACKGROUND: Intra-abdominal hypertension (IAH) is relatively frequent in critical patients. According to the most recent consensus of the World Society of Abdominal Compartment Society (WSACS), there are no predictive factors for IAH diagnosis. Risk factors are the only motivators to date for early IAH diagnosis. Abdominal compartment syndrome (ACS) is defined as sustained intra-abdominal pressure (IAP) maintained above 20 mm Hg (> 3 kPa), with or without abdominal perfusion pressure below 60 mm Hg (< 8 kPa), associated with a new organ dysfunction. Sepsis is a recognized cause of secondary ACS, but to date there is no correlation with admission SOFA (sequential organ failure assessment) score and ACS onset incidence. The objective of the present study is to determine the profile of extra-abdominal septic shock patients with IAH/ACS admitted to the intensive care unit (ICU) and correlating with admission SOFA score. Better understanding of this population may bring to light clinical predictive factors for IAH/ACS early diagnosis. METHODS: In this observational study IAH/ACS incidence was correlated with SOFA score calculated at ICU admission. The study enrolled all critically ill patients more than 18 years old admitted to the Medical Intensive Care Unit (MICU) of a university teaching hospital between April and October 2016, who had been diagnosed with extra-abdominal septic shock, according to the Surviving Sepsis Campaign and SEPSIS-3. RESULTS: Twenty-five patients were evaluated during 10 hospitalization days. The average age was 51.13 ± 16.52 years, and 64% of the patients were male. Most patients (76%) had pneumonia. On admission, the SOFA score was 6.54 ± 2.71. Mortality rate in the population studied was 52%. The incidence of IAH was 43.5%, while the incidence of ACS in the IAH population was 28%. SOFA admission score in patients with the diagnosis of ACS was of 8.42 ± 1.27. In this study SOFA score higher than 7 is correlated with IAH, with an accuracy of 68.8% (P < 0.03). CONCLUSIONS: The incidence of ACS in patients with extra-abdominal septic shock admitted to a university teaching hospital MICU was higher than those found in the literature. Higher admission and consecutive SOFA score of more than 7 was associated with higher ACS incidence and higher mortality rate.

Clinical warning signs for intra-abdominal hypertension in septic shock patients.

BACKGROUND: The latest World Society of the Abdominal Compartment (WSACS) guideline published in 2013 states that risk factors are the most reliable predictors for the diagnosis of intra-abdominal hypertension (IAH) and the bottom line to guide propaedeutic and clinical practice. The objective of this study is to search for clinical, laboratory, and ventilator-associated factors in order to warn medical staff for prompt IAH diagnosis in septic shock patients beyond risk factors simply. METHODS: This is a prospective, observational study, involving all admitted intensive care unit septic shock patients of a single teaching hospital between April and October 2016. All enrolled patients met Sepsis III and Surviving Sepsis Campaign diagnostic criteria. Patients with primary abdominal conditions were excluded, in order to avoid possible bias. Intra-abdominal pressure (IAP) was measured every 6 hours in accordance with WSACS guidelines. RESULTS: 25 sequential patients were included and followed for 10 days after admission. Median age was 51.13 ± 16.52 years old, 64% male. Pulmonary infection was the most frequent etiology of sepsis, representing 76% of the cases. Elevated IAP correlated with higher central venous pressure (CVP) (P = 0.0421); positive end-expiratory pressure (PEEP) (P = 0.0056); elevated airway pressure (P = 0.0015); accumulated fluid balance (P = 0.0273), and elevated SOFA (P = 0.0393) in all septic patients. Reduction of acidosis (P = 0.0096) and increase of serum bicarbonate (P = 0.0247) correlated with lower IAP values. CONCLUSIONS: Elevated CVP, PEEP, SOFA, airway pressure and accumulated fluid balance are correlated with elevated IAP in septic shock patients. Acidosis correction appears to decrease the risk for IAH. Multicentric randomized studies are needed to confirm this hypothesis in a large population.

Association between congenital heart defects and severe infections in children with Down syndrome.

INTRODUCTION: There is a high prevalence of congenital heart disease (CHD) in Down syndrome (DS) patients. Children with DS and CHD also present greater susceptibility to pulmonary infections than those without CHD. AIM: To investigate the prevalence and types of CHD and their association with severe infections in children with DS in southern Brazil seen in a reference outpatient clinic. METHODS: Children aged between six and 48 months with a diagnosis of DS were included consecutively in the period May 2001 to May 2012, and the presence of CHD and severe infections (pneumonia and sepsis) was investigated, classified and analyzed. RESULTS: A total of 127 patients were included, of whom 89 (70.1%) had some type of CHD, 33 (37.7%) of them requiring surgical correction. Severe infections (pneumonia and sepsis) were seen in 23.6% and 5.5%, respectively. Of the cases of pneumonia, 70% had associated CHD (p=0.001) and of those with sepsis, 85% presented CHD (p=0.001). CONCLUSIONS: Our study showed a high prevalence of CHD and its association with severe infections in children with DS seen in southern Brazil.